Spreading depolarizations occur in human ischemic stroke with high incidence
Spreading depolarizations occur in human ischemic stroke with high incidence
复制标题
DOI：
10.1002/ana.21390
复制
发表时间：
2008-06-01
影响因子：
11.2
通讯作者：
Graf, Rudolf
中科院分区：
文献类型：
--
作者：
Dohmen, Christian;Sakowitz, Oliver W.;Graf, Rudolf
目的：在各种实验性中风模型中，皮质扩散性抑制（CSD）和梗死周围去极化（PID）已被证明可引起继发性神经元损伤和梗死扩大。几十年来，人们一直质疑CSD或PID是否发生在人类缺血性卒中中。在这里，我们描述了通过硬膜下皮质电描记术（ECoG）检测到的恶性大脑中动脉梗死患者的CSD和PID。方法：脑损伤去极化合作研究中心（COSBID）招募了16名患有大面积大脑中动脉梗死的患者。在减压hernicraniectomy手术中，电极条被放置在梗死周围区域，从其中四个FCoG通道acquisition.Results：共记录了1,638小时，平均监测时间每例患者为109.2小时。共观察到127例CSD和42例PID事件。在CSD中，在相邻通道之间传播的刻板的缓慢电位变化伴随着ECoG活动的短暂抑制。在PID中，尽管已经建立了ECoG活动的抑制，但在相邻通道之间传播缓慢的电位变化。大多数CSD和PID在集群中重复出现。除2例患者外，所有患者均观察到CSD或PID。在这两名患者中，电极条已被放置在梗死组织，因此，没有当地的ECoG或反复短暂的去极化活动发生在整个observationperiod.Interpretation：CSD和PID自发发生在本研究中的恶性大脑中动脉梗死患者的高频率。这表明，闭塞性卒中的大量实验研究涉及其病理生理学中的扩散性去极化，可以在适当谨慎的情况下转化为患者及其治疗。
Objective: Cortical spreading depression (CSD) and periinfarct depolarization (PID) have been shown in various experimental models of stroke to cause secondary neuronal damage and infarct expansion. For decades it has been questioned whether CSD or PID occur in human ischemic stroke. Here, we describe CSD and PID in patients with malignant middle cerebral artery infarction detected by subdural electrocorticography (ECoG).Methods: Centres of the Co-operative Study of Brain Injury Depolarisations (COSBID) recruited 16 patients with large middle cerebral artery infarction. During surgery for decompressive hernicraniectomy, an electrode strip was placed on the periinfarct region, from which four FCoG channels were acquired.Results: A total of 1,638 hours was recorded; mean monitoring time per patient was 109.2 hours. A total of 127 CSD and 42 PID events were observed. In CSD, a stereotyped slow potential change spreading between adjacent channels was accompanied by transient depression of ECoG activity. In PID, a slow potential change spread between neighboring channels despite already established suppression of ECoG activity. Most CSDs and PIDs appeared repetitively in clusters. CSD or PID was observed in all but two patients. In these two patients, the electrode strip had been placed over infarcted tissue, and accordingly, no local ECoG or recurrent transient depolarization activity occurred throughout the observation period.Interpretation: CSD and PID occurred spontaneously with high frequency in this study of patients with malignant middle cerebral artery infarction. This suggests that the large volume of experimental studies of occlusive stroke that implicate spreading depolarizations in its pathophysiology can be translated, with appropriate caution, to patients and their treatment.